Journal of cataract and refractive surgery最新文献

Purpose: To compare the capsulotomy rim morphology of anterior lens capsules obtained by 5 femtosecond laser-assisted cataract surgery (FLACS) platforms: Catalys, FEMTO LDV Z8, LensAR, LenSx, and Victus.

Setting: University of Basel, Basel, Switzerland.

Design: Experimental study.

Methods: Anterior lens capsules from 6 interventions per laser platform were collected (N = 30). 4 of each were assessed under light microscopy (LM; n = 20), and 2 were assessed under scanning electron microscopy (n = 10). A qualitative evaluation of all samples was conducted, as well as a semiquantitative analysis of the extent of irregularities present in LM samples. The Dunn multiple comparisons test was conducted to determine which lasers produced significantly smoother capsulotomies.

Results: Irregularities along the lens capsule rim were observed in all samples. Distinct irregularities were observed for Catalys (unconnected laser pulses bordering the capsulotomy), FEMTO LDV Z8 (numerous additional rows of laser pulses), and LensAR (at least one section with multiple rows of laser pulses). Victus demonstrated a significantly higher degree of smoothness of capsulotomy (median = 306 degrees) compared with Catalys (median = 171 degrees) ( P = .02). The medians for other laser platforms fell between these values.

Conclusions: Different laser platforms produce morphologically and quantitatively distinct irregularities, which may influence capsulotomy strength differently. FEMTO LDV Z8, a low-energy laser, did not produce a smoother capsulotomy than the high-energy lasers. Our results suggest that, with current technologies, the precision of the laser is more important than the pulse energy in determining the regularity of the capsulotomy surface.

Purpose: To study the efficacy of intracameral moxifloxacin 0.5% in prevention of postcataract surgery endophthalmitis.

Settings: 3 tertiary eye centers of northern India.

Design: Multicentric randomized clinical study.

Methods: 60 000 eyes undergoing phacoemulsification with intraocular lens (IOL) implantation were randomized in 2 groups in 1:1 format from January 2018 to June 2024. Group 1 received intracameral moxifloxacin (cases), whereas group 2 did not receive intracameral antibiotics (control). Any case of endophthalmitis in the postoperative period up to 6 weeks in both groups was documented and managed according to routine protocols.

Results: The endothelial cell counts were comparable preoperatively ( P = .18) and postoperatively ( P = .54). 6 eyes (0.02%) in the intracameral moxifloxacin group developed endophthalmitis as compared with 16 eyes in the control group (0.05%) ( P = .04). The odds of developing endophthalmitis were 2.5 times lower with the usage of intracameral moxifloxacin. The mean time of presentation of endophthalmitis in groups 1 and 2 was 32.26 ± 23.42 days and 23.52 ± 13.91 days, respectively. 8 cases (8/22; 36.36%) were culture-positive of which one was fungus (n = 1/8; 12.5%), while rest were bacteria (n = 7/8; 87.5%). Coagulase-negative Staphylococcus was the most commonly isolated microorganism (n = 4; 50%). Resistance to fluoroquinolones was higher for ciprofloxacin (5/7) and gatifloxacin (3/7) than moxifloxacin (2/7). At 3 months, 17 of 22 eyes (77.27%) responded to treatment and endophthalmitis resolved by 3 months. However, 1 eye in group 1 and 3 eyes in group 2 developed phthisis (4/22; 18.18%).

Conclusions: Intracameral moxifloxacin is safe and effective in preventing postcataract surgery acute bacterial endophthalmitis.

Purpose: To characterize clinically and morphologically the opacification of a specific type of intraocular lenses (IOLs).

Setting: Miranza IOA, Madrid, Spain.

Design: Ambispective observational study.

Methods: 59 eyes of 50 patients who underwent cataract surgery between 2010 and 2017 with implantation of various Lentis Mplus IOL models developed IOL opacification. The opacification was assessed through slitlamp examination and anterior segment optical coherence tomography (AS-OCT). Its impact on visual acuity (VA), far contrast sensitivity (CS), and near vision satisfaction using the 10-item Near Activity Visual Questionnaire.

Results: The mean time to IOL opacification development was 56.4 ± 24.0 months. The most common opacification patterns were total diffuse (44.1%), peripheral plaque (33.9%), and miscellaneous (8.5%). Both uncorrected and corrected distance and near VA significantly worsened on detection of IOL opacification ( P < .001). Mean CS values for 6, 12, and 18 cycles per degree fell outside the range of normality. Fewer than 8% of patients reported extreme difficulties performing near vision tasks. OCT measurements revealed mean maximum and minimum opacification thicknesses of 72.2 ± 24.6 and 51.8 ± 21.2 μm, respectively. IOL explantation was required in 8 eyes (13.6%), with significant VA improvement after IOL exchange ( P < .001). Severe postoperative complications occurred in 3 patients after explantation.

Conclusions: Opacification of Lentis Mplus IOLs typically presents with a diffuse pattern, leading to deterioration in VA and CS. This complication can be managed by exchanging the opacified IOL with a fully transparent alternative; however, the surgical procedure carries inherent risks that require careful consideration.

Purpose: To investigate the spatial placements of the horizontal and vertical ciliary sulcus through ultrasound biomicroscopy (UBM) analysis.

Setting: Eye and ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective observational clinical study.

Methods: This study comprised 82 eyes of preoperative implantable collamer lens (ICL) candidates with myopic ICL. UBM was used to measure the ciliary sulcus-to-sulcus (STS), central distance from endothelium to STS (ASL) crystalline lens to STS (STSL), the angle-to-angle distance (ATA), and anterior chamber depth (ACD) to crystalline lens in both the horizontal and vertical orientations. Mean keratometry, axial lengths, and horizontal white-to-white distance were also recorded.

Results: The mean ASL was 3.574 ± 0.183 and 3.725 ± 0.198 mm, while the mean STSL was 0.488 ± 0.175 and 0.629 ± 0.161 mm in the horizontal and vertical orientations, respectively ( P < .001). The vertical STSL (vSTSL) exceeded the horizontal STSL (hSTSL) by a mean difference of 0.141 ± 0.128 mm, and similarly, the vASL exceeded the hASL by a mean difference of 0.151 ± 0.137 mm. Both the hSTSL and vSTSL showed a negative correlation with ACD ( P < .001). The difference in STSL (vSTSL - hSTSL) was positively correlated with vSTSL, vASL, and the difference in STS (all P < .05) and negatively correlated with hSTSL and hASL (both P < .05).

Conclusions: The ciliary sulcus is typically located more posteriorly in the vertical orientation than in the horizontal orientation.

Purpose: To explore the effects of the 2 surgical methods on the short-term and long-term visual outcome of patients with congenital ectopia lentis (CEL).

Setting: Eye & ENT Hospital of Fudan University, Shanghai, China.

Design: Prospective comparative study.

Methods: All patients were divided into 4 groups according to age and operation method: children underwent in-bag or out-of-bag surgery and adult underwent in-bag or out-of-bag surgery. They were followed up 1 month, 3 months, and every 6 months postoperatively. Their corrected distance visual acuity (CDVA), axial length (AL) growth, prediction error (PE), and other parameters were recorded, compared, and analyzed.

Results: There was no significant difference between CDVA and PE in the same age group compared by surgical methods. CDVA in adults was better than that in children, but greater myopic drift occurred in PE. In general, CDVA of the 4 groups all showed a trend of improvement with the addition of follow-up years, while PE increased gradually. The rate of AL growth was lower in patients undergoing in-bag surgery than in patients undergoing out-of-bag surgery.

Conclusions: Both in-bag and out-of-bag surgeries are safe and effective for patients with CEL. CDVA and PE were not affected by the type of surgery and were only related to the patient's age. However, the growth rate of AL will slow down in in-bag surgery. No matter children or adults, half a year after surgery is the window period for recovery, and active amblyopia training has significant implication for the recovery of visual quality.